Depression Panic Attacks

Depression and Panic Attacks can often be linked. There is a simple reason for this and that is that low levels of the neurotransmitter Serotonin can lead to both depression and panic attacks.

What’s more, people who suffer from panic attacks often find themselves placing restrictions on their lives. For example someone who experiences panic attacks may become to a greater or lesser extent agoraphobic. Agoraphobia being basically a fear of panic attacks.  If you start to fear things that you used to do easily you may well become depressed and frustrated.

So depression and panic attacks might coexist because of the same cause, or because one leads to the other.


Certainly, the treatment you choose for one would most likely effect the other. For example SSRI anti-depressants like Celexa/Citalopram are often used to treat panic disorder, although the dose may need to be altered to be effective for panic.

Likewise, a course of CBT (Cognitive Behavioral Therapy) will teach you how to think more rationally and not be afraid of the symptoms of panic attacks. The same techniques can happily be applied to depression and the negative thought trains which surround it.


So basically establishing the link between panic attacks and depression is not really necessary for effective treatment.

Xanax Anxiety

Xanax, also known by the generic name Alprazolam, has been licensed in the USA to treat anxiety and panic attacks since 1981. It is used in the treatment of anxiety disorders, panic disorder and, in some cases, depression. It is a member of a family of drugs known as Benzodiazepines. It is a mild tranquilizer.

Many people who have experienced drugs like Valium may be aware of how Benzodiazepines can make you feel doped and sleepy. Xanax is not like this for many people. In my own personal experience Xanax didn’t make me feel very different at all, just much much calmer. I didn’t get any of the side effects listed, and in an ad hoc experiment to see how my reaction times were effected I actually found my reactions to be almost exactly as good as when I wasn’t on Xanax.

Some people do suffer from side effects, sleepiness, dizziness and vertigo, nausea. But these drugs are rather well-tolerated.

In terms of dose, it is important to follow your doctor’s instructions. I personally worked my way up from the 0.25mg dose which is the lowest available and now take 1.5mg on an as needed basis.

Initially I took a tiny amount of one Xanax tablet to see how I tolerated it. As I was fine I took the rest. Some people who suffer from anxiety may have a psychosomatic side effect of feeling a sudden onset of anxiety or panic whenever they try something new. This can mean that at first a Benzodiazepine has a paradoxical effect. If I were you I would persevere, as for the short term relief of temporary anxiety and panic attacks this drug is very useful and very effective.

A word of caution. Like all Benzodiazepines, Xanax can be habit forming. If you take it for too long you may need to taper off slowly to avoid withdrawal effects. Also, if you take it often you may find you need to take more to get the same effect. Your doctor will be able to advise you on this.

I don’t recommend you buy from online pharmacies without prescription, you don’t know what you are getting or how safe it is, or even if it will arrive or not!

See also:

Xanax for travel anxiety.

Medication for Anxiety

There is lots of medication for anxiety available on the market. Almost all of it is only available on prescription from a doctor.

Normally, Patients presenting with anxiety are offered Selective Serotonin Re-uptake Inhibitors (SSRI for short). This family of medication is considered suitable if the anxiety disorder is ongoing, as SSRI’s are not suitable for short term use. They tend to take at least four weeks to start working (although some people claim to feel better in as little as two days) and aren’t thought to be fully effective until they have been taken for 6 weeks to two months. The common SSRI’s are:

Other drugs which might also be prescribed and are similar to SSRI’s are SNRI’s or Serotonin-norepinephrine Reuptake Inhibitors. The most commonly prescribed SNRI is Venlafaxine (Effexor). SNRI’s are newer than SSRI’s and tend to be slightly better tolerated with fewer side effects. They were designed to treat depression but are also a medication for anxiety. Likewise they are prescribed for long term use, normally six months or more and sometimes years.

Also read this post on Anxiety Medication Over The Counter.

If a medication for anxiety which is short term is needed then there are various other options. In times of extreme grief or pain, or when panic attacks are severe, a short acting anxiolytic might be used. The normal choice would be one of the Benzodiazepine family:

  • Xanax, alprazolam:
  • Lexotan, bromazepam:
  • Librium, chlordiazepoxide:
  • Klonopin, clonazepam:
  • Tranxene, clorazepate:
  • Valium, diazepam:
  • Rohypnol, flunitrazepam:
  • ProSom, estazolam:
  • Dalmane, flurazepam:
  • Paxipam, halazepam:
  • Dormonoct, loprazolam:
  • Ativan, lorazepam:
  • Versed (Hypnovel, Dormicum), midazolam:
  • Mogadon, nitrazepam:
  • Serax, oxazepam:
  • Doral, quazepam:
  • Restoril, temazepam:
  • Halcion, triazolam:

Benzodiazepines are good because they work quickly (less than an hour even) and are very good at what they do – stopping anxiety and panic. In a way they are the ultimate medication for anxiety. The problem is that if they are taken for too long they become less effective and can become addictive. Constant use for more then three weeks is rarely advised. For a personal experience of Valium click here.

Another drug that is not a Benzodiazepine is Buspirone, which is said to be as good as a Benzodiazipine for reducing anxiety but non-addictive and non-sedating. It has a better side-effect profile but can not be taken on an as needed basis. It has to be taken daily and takes two or three weeks to take effect. As it is non-addictive it is much better suited to long-term use Benzodiazepines.

Treatment for Anxiety

Choosing the best treatment for anxiety is a potential minefield. There are two many treatments out there to name ranging from the clinically proven to the wacky and bizarre.

My first piece of advice is to do some Cognitive Behavior Therapy. I am not saying that CBT cures anxiety or that it is the best treatment for anxiety. What I am saying though is that the cognitive skills learned in CBT form the back bone of positive thinking and changing thought patterns.

It the bad old days CBT was expensive and your insurance or health service would only let you have a few miserable sessions. Now CBT is much more in your control. You can read some great books on CBT which have practical exercises and seeing an expert might not be necessary at all. There is another option that has become increasingly popular and that is computerized CBT. You can use this online and it takes you through various exercises. There are many websites offering this service for free or a nominal price. Moodgym is one such.

In an article about treatments for anxiety it would be normal to talk about drugs, medication and herbs. i won’t talk about any of those because they don’t treat anxiety, they mask the symptoms.

I will however talk about nutrition. Anxiety can be causes or exacerbated by a lack of Omega 3 fats and some vitamin and mineral deficiencies. You should consider supplementing with a good quality fish oil that has a high EPA content. Also, make sure you are getting enough B vitamins.

If you have IBS your stomach may not absorb vitamins and minerals well enough. This could lead to deficiencies so a modified diet which avoids food which you can’t tolerate may help in the long term. There is certainly a link between IBS and Anxiety.

For more on drugs read Anxiety Medication Over The Counter.

Lastly you need to learn how to relax. A CBT therapist will teach you breathing and relaxation exercises but in my opinion there is nothing better for anxiety than mindfulness meditation. The simple act of becoming aware of what is around you, living in the present moment, observing thoughts without letting them become you or take you over, is the most calming thing. Like all good things it comes to those who wait, or to be more precise those who are patient and can practice mindfulness regularly.

Social Anxiety

Social Anxiety can be described as a feeling of fear or dread that arises because of a social situation, intense shyness, guilt and shame. Social Anxiety may be felt before a situation in anticipation of it, during a social interaction or afterwards, as the sufferer over-analyses the interaction and feels ashamed or guilty about what happened.   Some people decide to completely avoid all social interaction, this is called Social Phobia.

Social Anxiety Disorder symptoms are just like any those for any other aspect of generalized anxiety disorder in many ways. The physical symptoms are often the same: palpitations, hyperventilation, muscle tension, nausea and vertigo. In some cases however a social anxiety sufferer may blush or stammer uncontrollably. In some cases they may even freeze, and be unable to speak.

Treatment for Social Anxiety

As Social Anxiety is caused by faulty thinking and physical symptoms that lead back into those faulty thinking patterns in a vicious circle the first line psychological treatment is often Cognitive behavior Therapy. With CBT a therapists will help you identify faulty thinking patterns or individual beliefs and then correct them or rationalize them.

The therapist will also teach some relaxation techniques to break the flight or fight cycle. CBT can be very effective and is often easily available although it can be expensive if you are not insured. There are many good books on the subject which can be as worthwhile as seeing a professional and much cheaper.

Doctors will often also prescribe drugs. Medication for Social Anxiety often takes the form of SSRI’s such as Citalopram (Celexa). These work by increasing Serotonin levels in the brain and improving mood and confidence.

Another type of drug that can be prescribed for social anxiety is a beta-blocker like Inderal. It doesn’t cross the blood-brain barrier sand therefore doesn’t effect mood but can be good for Social Anxiety because it blocks some of the adrenaline and therefore lessens the physical symptoms. This allows the sufferer to build confidence.

One vitamin, niacinamide, which is a form of vitamin B3, has been found in high doses to be beneficial for social anxiety. Scientists are divided over how it works and indeed if it works. On the consumer health rating site Revolution Health, readers have praised it’s effectiveness so it might be worth investigation and talking over with a doctor. There are safety concerns over taking high doses of Niacinamide.

Generally there is a good chance of a positive outlook for people with social anxiety. The numerous treatments available have a good chance of success and your doctor should be your first line of attack.

See Also

Do I have Social Phobia

Panic Attack Symptoms

Panic Attack Symptoms can be similar to anxiety# symptoms but usually feel much more intense. Often people say things like “I feel like I’m losing it” or “It felt like I was going mad”. In fact neither of those things are true, but as Panic Attacks cause such a rush of adrenaline and your body is so tense some quite bizarre symptoms can develop.

The typical symptoms are:

Racing heart (palpitations)

Feeling like you are going to have a heart attack

Increased breathing (hyperventilation)

Dizziness or vertigo

A feeling of unreality or depersonalization.

Sweating or feeling hot or sometimes cold

The great news is that all of these symptoms are harmless. They have been specifically designed by nature to feel as unpleasant as possible to encourage you to take action, but they are designed to protect you not harm you.

Many people find the feeling of unreality the hardest to cope with. Some people report that colors become more vivid, like when the sun is low at the end of summer. Or that sound is out of sync or doesn’t sound real, and that people don’t seem real. Some people think that this is a symptom of fainting, but in the case of panic attacks fainting is very rare, as blood pressure is raised somewhat and people normally faint from low blood pressure. I have never known anyone faint from panic.

Other people  feel like they are having a heart attack, and if you have experienced an elevated heart rate you should have this checked out by a doctor just to be safe. Many people who are admitted to emergency rooms feel they are having a coronary but are in fact just panicking.

There are lots of treatments for panic attacks.

Also read more on feelings of unreality.

And a little more on feelings of unreality!

Treatment for Panic Attacks

Treatment for Panic Attacks in mainstream medicine revolves around two things: medication and CBT (Cognitive Behavior Therapy).

Medication tends to fall into two categories: SSRI’s and Benzodiazepines.

The SSRI’s, like prozac, celexa, zoloft etc have pros and cons. They are clinically proven to be effective (although all data from big pharma companies has been called in question at sometime or other). Unfortunately they do have side-effects of which weight gain, nausea (normally temporarily) and sexual dysfunction/loss of libido  (normally temporary) are the most severe and commonly reported. SSRI’s normally take 4-6 weeks to start working and may need to be tapered off slowly at the end of treatment.

Benzodiazepines, like Xanax alprazolam and valium also have pros and cons. They are fast working, normally taking considerably less than an hour to kick in, and are extremely effective. On the downside they can be highly addictive and therefore are not best suited to long term use (although they are prescribed long term sometimes). They also can effect concentration and alertness so hinder the consumer’s ability to drive for example.

On the CBT front, over ten or twelve sessions a trained therapist will help you see panic attacks for what they are (harmless natural responses which appear nasty), will show you how to rationalize out the faulty and extreme negative thinking which causes panic attacks, and show you some physical techniques to calm your breathing and relax your mind and body.

Some people argue that CBT doesn’t really get to the heart of the problem, that you need some kind of psychotherapy to do that. Others argue psychotherapy is a pointless and long-winded waste of money.

Often a combination of therapy and drugs work best.

There are other potential treatments for panic attacks involving herbs and supplements like 5-htp which many people swear by. It should be noted that the effects of long term use of these other therapies has not bee fully studied.

Physical Symptoms of Anxiety

Physical symptoms of anxiety can be mild or severe and for some people are worse than the mental symptoms. The physical symptom which worries people most is a racing heart or palpitations. Often with anxiety the heart can race to similar pulse rates as if you were running, and for many people this is the beginning of a panic attack.

As anyone who works in an Emergency Room or an Accident and Emergency department will tell you, it is very common for people to be admitted who are convinced they are having a heart attack. In fact this racing heart is just the bodies way of preparing for danger, the fight or flight response. Like all physical  symptoms of anxiety, it is harmless.

The second most common symptom of anxiety is often described as tightness in the chest. This tends to be a combination of two things: a slight narrowing of the airway caused by the increased blood flow through the veins in the neck and hyperventilation. The combined effect is a feeling that we can’t breath, but this is just a feeling. In fact our breathing is working fine, again the fight or flight response is preparing us for action. The problem is that as we feel we can’t breath so we try to breath more and end up gasping for breaths we don’t need, when in fact we want to be slowing down our breathing, and taking calming belly breaths instead of fast shallow chest breaths.

Other physical symptoms of anxiety include tingling in the limbs, which is caused by blood being diverted to the core of the body,  and a feeling of weakness which comes about for the same reason.

How do I stop the physical symptoms of anxiety?

The best way to stop anxiety symptoms is to start off the Parasympathetic Relaxation Response. This natural nervous system response to the fight or flight response is designed to calm us down after the danger has passed. As there is no real danger from an anxiety attack or a panic attack we can calm ourselves down immediately quite safely.

How do we set the relaxation response in motion? Well, there are several ways. Meditation is one and I recommend Mindfulness Meditation, which will also help you become aware of your breathing and recognize when you are hyperventilating unnecessarily. Learning to meditate takes time and commitment but will be worth it.

In the meantime, you can elicit the relaxation response by re-breathing carbon dioxide by breathing into a paper bag, or my concentrating on things at the periphery of your vision.

Remember though one important thing. the physical symptoms of anxiety are harmless!

Signs and Symptoms of Anxiety

Signs and Symptoms of Anxiety can be hard to spot. Not because they are subtle and mild – often they are not – more because they can be easily confused. I have heard of one person for example whose doctor thought he had epilepsy and sent him for an EEG scan.

Anxiety symptoms can be straight forward:

Hyperventilation

Palpitations

Churning Stomach

Difficulty breathing

These are the ones that people often mention. But there are many other symptoms that might also indicate anxiety or extreme stress:

Irritability

Vertigo/dizziness

Insomnia

Nausea

Upset stomach (diarrhea/constipation etc)

Feelings of unreality (feeling disassociated, disconnected or odd/ungrounded)

Restlessness

Playing with hands or touching ones face or forehead.

Looking around as if for an escape route.

This list is not exhaustive, but it gives an idea of the range of anxiety signs and symptoms that could easily be confused with something else. Of course the reverse is also true, which is why it is imperative to have a complete medical check for other possible physical causes of these symptoms.

Some  physical disorders that cause anxiety symptoms are Thyroid problems (both over and under active thyroids), food allergies and intolerances, vitamin and mineral deficiencies and IBS.

Anxiety Niacinamide

Does Niacinamide work for anxiety? Well, There are a few reasons why I think it might be worth a try. Firstly, a proper scientific study found that Niacinamide had anti-anxiety (anxiolytic) effects in animals (Tallman JF, Paul SM, Skolnick P, Gallager DW (1980).

Some  people have hypothesized that Niacinamide works on the same receptors as Benzodiazepines like Valium and Xanax.

Further more, if the body does not get enough Vitamin B3 through diet, it can make it from Tryptophan. This is not good for anxiety sufferers as Tryptophan is the amino acid the body uses to make the good mood chemical Serotonin, a lack of which causes anxiety and depression. Therefore it might be the case that taking on more B3 in the form of Niacinamide lessens the necessity to divert Tryptophan away from Serotonin and therefore boosts mood and calm anxiety that way.

On top of that, B Vitamins are essential for correct brain and nervous system functioning.

Lastly, other people with anxiety that have expressed an opinion swear by Niacinamide. Not everyone of course, nothing works for everyone. But when someone else has tried something and had success it is generally worth a shot!

How much Niacinamide should I take for anxiety? That is another very good question which it is quite hard to answer. I have read conflicting advice and of course there is no decisive answer from medical circles. The Reference Daily Intake (The Recommended Daily Allowance in the UK) varies from country to country but is often around 50-20mg depending on age and gender.

Doctors that advocate Niacinamide as a treatment for anxiety recommend much much higher doses. Sometimes as high as 3000mg a day. It is thought that doses beyond that can cause liver toxicity.

In terms of dosage I would say you have to be careful. Take medical advice if you can and start on a lower dose and move up and see if you get any anti-anxiety effects. If so, why not check with your doctor that the dose is safe in their opinion, or see if they can monitor you for liver function if the dose you are using is extreme.